Vaccine mandates are on the way. They are coming to many business in the private sector and even to cities and communities. The US military and the Department of Defense has announced impending mandates for service members. This is a special population with slightly different contrstraints compared to civilians.
This episode explores the historical precedent of controversial mandatory vaccination in the military. I discuss the implementation of mandatory Anthrax vaccination and where that program currently stands.
I would love to hear your thoughts on this issue!
Welcome to Curbside Ethics. So happy you tuned in. Please share with your fellow clinicians and leave a rating or comment on iTunes. Visit www.StevenBradleyMD.com to request a personalized ethics consultation from our host.
Transcription
Hello and welcome back to Curbside Ethics, I’m Dr Steven Bradley, an anesthesiologist, clinical medical ethicist and your host for this podcast. I really didn’t intend for cursed had this to center entirely around Covin nineteen and tax administration, but these topics keep coming up in the news and I definitely want to address things that are relevant to our practice as we push and lean towards employer mandated opinnion back nations. One of the biggest things to you deny out for is the department of events no surprise at the military, had a lot of mandates and things that service members who have signed up to follow orders essentially in protecting to find constitution all. But it’s no surprise that at some point they were likely going to be mandated to take this vaccine as I get started. I do want to make it clear that this is my own opinion. This does not reflect the opinions of the Department of Defense to the United States may be I’m just in case. You were thinking otherwise. So recently the pending on, has moved towards making the accint menitares for several members. And what exactly? Does that mean? How does that play out for the potins boots on the ground? Currently, the military functions under some slightly different ethics, I’ll probably cover at in a different episode, but once to you sign on the dot line is wear in. Obviously, you are taken an oath to protect, defend the constitution to go to war and risk your life. If need be, one thing that you don’t quite receive good and form to consent on when you’re joining the military is in the realm of health care and the protection of your own body. We know you’re going to go off to war potentially and get shot at and all these bad things and happen. But we don’t really talk about the implications on one’s own health care because there is sublimitas and effect on the medical decisions for individual service members. The military kind of leans heavily on utilitarianism, in the sense that we are all one fighting force and they typically prioritize the good of the majority, as opposed to the health of the individual soldier or sailor, and this doesn’t frequently come up, but it does play out in different situations, one of which would be with these covin nineteen fascinations there’s a phrase that will come up again and again, and that is the maintenance of a healthy ready, toughing force. This was in a memo from Secretary of Defense, General Lloyd, Austin. He said O en mo that we need to defend this nation. We need a healthy and ready force and he strongly encourages all department, Defense, military and civilian personnel to get vaccinated now and for military service members to not wait for the mandate, just kind of couching his language a bit because we’re not quite at the place where we can mandate this vaccination. The Pentagon cannot unilaterally mandate this because a food and Drug Administration has not yet fully approved this vaccine. If they were to mandate it now, they department of Defense would require a waver from the president, which may be asked for in the near future. Once the vaccine has been approved at a food drug administration, individual services can draft up plans to implement meditare vaccination for their service members. Alternatively, if the president issues a waiver, then it falls to the individual services to to draft those plans as well. The same time that General Austin released his statement. The White House released a statement where President Biden voice his strong support of mandating the vaccine and encouraging people to receive the vaccine, but he did stop short of this issuing that waver. Currently roughly seventy three percent of acuity service members have received at least one dose of the vaccine with sixty percent being fully vaccinated. This is reported in an article published by NPR. I honestly didn’t think it was that high, I think, there’s a fair amount of vaccine, hesitant Ted military, but these are the numbers that that they reported in this article by NPR. They continue on that. They want to appeal to a sense of team work among the unvaccinated service members and it’s their opportunity to contribute to the health and readiness of the team. So again that concept of we are all one team, one fight already. If you join the service, there was about seventeen different vaccines that you may be required to receive, and it depends on where you’re applying to a couple years ago, I was out on the hospital ship and we’re goingthrough South America, Central American Acri, and actually had to get the yellow fever vaccine, so vaccine mandates aren’t new. Obviously, a lot of these vaccines are already FDA approved, and that is again the difference with the Covin nineteen vaccines and the vaccines that are currently mandated. Depending on your area of service. A lot of parallels have been formed between the Covin nineteen vaccine mandates and the anthrax vaccination mandates. So I want to kind of review the in four percent: The military with regards to anthrax, vaccination again, the sinners around informed consent in your ability to protect your own body and prevent other people from intruding upon your own person with a form consent. You should be told of the risk and benefit of the medical treatment you’re going to receive and you should be able to provide consent prior to receiving this treatment again in four percent is fairly recent in terms of medical care and treatment, probably over the last hundred years it has evolved to where it is at this point to now. You know it is one of the most important aspects of receiving and providing medical care and for consent is essential and health care and medical research, and you know now we have preti consent forms even for the cove in nineteen vaccines, you’re able to receive informed consent prior to receive in fascination when you’re in the military. There is a different set of rules again every service member Swar, an oath and in doing so did give up some of their rights and protections that the general American citizen has like. I always say we, it’s rare, that you do not have the ability to make a choice: you’re, never free from the repercussions of those choices, but you still have a choice. Even if you swore an oath into the military, you can still retract that you can still take back control of your own body, but there are consequences right. So if you have a service commitment, you can’t just quit the military. There is a process that many many people go through. There are significant repercussions, could be some jell time could be demotions and rank. There are ways to leave the military if, for whatever reason you don’t agree with continuing to serve or you need to leave for whatever reason you decide, there are demands made in the military that exceed those demands that are made of most civilians and that requirement that a soldier, sailor or airman’s body is their own. It’s not the same as for a general civilian, along with these increased duties and heightened risk of military service. There is also kind of a lower requirement for informed consent to medical treatment in the military, and this differs if you’re in the state, a large hospital or military teamen facility or if you’re deployed in a war zone, the situation kind of dictates how that medical care proceeds with regards specifically to the anthrax vaccine. So initially the Military Establishes Anthrax Vaccine Emania Ion Program and they mandated innoculation using this vaccine, the anthrax vaccine had been approved by Food Drug Administration almost thirty years before this vaccine immunization program began. This was back in about nineteen s where they started to require this anthrax vaccine for service pomperses, a defense against biological warfare. With this mandate there was no consent required or requested prior to inoculation after this program came to be. There was a lot of questions that came out about the properties to vaccinations and whether service members were at undue risk without their informed consent. When receiving his vaccine. The anthrax vaccine was initially established in H S and was produced to protect animal high to workers they were being subjected to and contracting cutaneous anthrax through skin exposure to the vaccine was made to combat that type of of anthrax. It was estimated to be about ninety three percent effective back then. The military, however, was going to try to protect soldiers against inhalational anthrax and the form of biological weapons and Latina anthrax is a more potent form of the bacteria. There was no original study. The vaccine indicated that it provided protection to both of these forms. In the initial studies, there were only five cases of inhalational anthrax versus the twenty one cases of cutaneous anthrax after they started mandating. This vaccine soldiers started complaining of severe and significant thought effects to the point that some of them could no longer perform their dutiese. Some refuse vaccination, some had threats of being discharged or other negative punishments that could affect their career. Some soldiers even fold lawsuits that this violated their rights. With all of these complaints surfacing some senior leaders society to suspend the vaccination programs and through more research, they saw that one of the subs trades in the vaccine was likely causing worse side effects the side effects. Experience were severe joint pain memory laws, arthritis and up to thirty percent people that receive the vaccine were experiencing these symptoms in side effects. Eventually, the United States General Accounting Office is kind of a governing body that can look into military matters. They perform their own survey of National Garden Army members and their server results are consistent that the rate of adverse events from the vaccination was significantly higher than what was stated in the vaccine product insere. So it was worse than what the research showed and what was anticipated. In addition to the high rate of adverse events, this survey found that a large percentage of members were dissatisfied with or did not believe the information provided to them. Concerning this anthrax vaccine communization program, it’s not surprising that if you are forced to take a vaccination, you may not be super happy about it. So the morale of these units was pretty low. Regarding his vaccination, of course, if these soldiers had been allowed to consent for the vaccination, then most of them probably would not have been vaccinated at all, and that would have defeated the purpose of this immison program. Eventually, the judicial system became involved and different maries of the military begin to sue the government, as I’m discussing a previous episode, is very difficult to sue the government, especially when you’re on active duty military. But nevertheless, you know several. These law suits were filed since in form, consent was not required for service members. When the treatment was approved by the FDA, which is anthrax vaccine was. The primary argument was that the use of anthrax vaccination was experimental excremental because it had not been studied to work against the insulation Al Form of anthrax, since they felt like they were being used in an experiment. They were able to bypass some eliminations that typically prevent people from so in the government. The military is constrained by law when seeking to require members to participate in experimental treatment or use of a drug that is unapproved for its applied use. They must give notice of this information and the need to obtain consent in these situations. Technically again, the vaccine was not experimental, but the indicated used by the military for inhalational exposure was experimental. Six service members sue the Department of Defense, secutive of health and Human Services, and the Commissioner of the FDA, under the theory that the anthrax vaccine was experimental when you used to protect against inhalational anthrax, the Federal Court agreed and suspended the vaccinations unless informed consent was obtained or the president laved the consent requirement, which did not occur shortly. After that the food and Drug Administration announced a final rule that classified the vaccine is safe and effective independent of the route of exposure. Despite this, the Federal District Court again agreed with service members, the FDA’s previous practice for final roles mandated that there was a public comet period and since I’ve been eighteen years since it last listed, it comments on the Anthros vaccine. The court halted the involuntary inoculations. They stated that unless an until the food and drag administration follows the correct procedures to certify the anthrax vaccine absorbed as a safe and effective drug for its intenet use, the Department of Defense made a longer subject: military personnel to and voluntary anthrax vaccinations absent in form consent or presidential waiver, and this applied to all members of the military. So this program was halted back in two thousand and four. However, that did not mark the end of the program in two thousand and five. They modified this injunction at the request of the government. The Food Drug Administration had not yet approved the vaccine force attendant use, but a law enacted in two thousand and four permitted emergency used authorization which allows unapproved use of a drug by the military, based on a determination of a military emergency involving a heightened risk of attack with a biologic agent. So today, the Anthrax Vaccine imidation program is mandatory for service members serving in certain areas, and it is voluntary or encouraged for others. There is a whole website dedicated that where people can look up more information on mandatory anthrax, vaccination coming back to present Tom, with the cover intin vaccine again, we expect that these vaccines will be fully authorized in your future is when they get a lot of these issues with the form, consent and the mandates when it comes to an for consent. The military, if a soldier, sailor or airman refuses e mandated vaccination, they do or may suffer repercussions we’re always free to make. These decisions were not free from the consequences of the decisions that we make, that individual may be demoted. They may be discharged they made in face jel time for discipine. A direct order in the military doesn’t really like to take these courses of action, because the press is just horrible. It’s going to hurt retention, numbers and recruitment. So typically these drastic measures- they don’t come to that people just kind of get quietly, dismissed or or whatever happens. However, in the military, there are still valid arguments for providing certain treatments without consent, where the health of the individual or of the whole, so that the military team, where their health is at spick. Although it’s true that the armories are exempt for many rules, that govern the conduct of private citizens to require treatment and down to have a relatively high incidence of side effects, does test the limits of these arguments. At some point, there is so much resto person that we should not be able to wave in form consent. Obviously, with these covet in tin, vaccines, there’s a much better risk in side effect profile, and these vaccine nations are absolutely indicated for service members. A lot of times, folks, going on ships a river back in the start of the cubic nineteen pandemic, with the military side to send hospital ships up to help out with cobet surges, and I was initially checked in on the US and as comfort preparing to hell to New York City and all the rules and instructions from the CDC talking about social distancing and masking all those rules are circulating and we had muster, which is like a get together. Essentially, it’s a big meeting on the ship to discuss a plan for deploying to New York and in this large room were well over a hundred hundred and fifty people standing shoulder with a part. So literally, everything that had been recommended by special distancing was not being followed, was impossible to follow social desisting mandates and recommendations, whether you’re working on a hospital ship or whether you’re on an aircraft carrier or submarine summaries, breathe, recycled air the whole time but they’re underwater. So in this setting, it doesn’t take much for diseases to spread most aircraft carriers when they deploy. They go through a bout of neurobiologist rips through the entire crew. They call it the Double Dragon, because there is a forceful explosion from both ends of the alimentary track. I guess is a nice way to put it and everybody goes through, that they get symptom relief, IV Ofria, all that, and eventually everybody just kind of passes it. So these diseases absolutely spread, essentially your own crew ships. We saw what happened with those in the pandemic, so for the military, it is absolutely crucial that are soldiers. Sailors airmen receive, is vaccine and will be the best for maintaining a healthy, ready fighting force, as well as decreasing his bread of this pandemic and helping us return to a normal way of life thanks so much for listening. Hopefully, you learn something new from his episode. A lot of information I got from an article by NPR was entitled the Pendergast Moved Toward Making Vaccines Mandatory for service members. This was written by a James, DUBEC and published about August Nineteenth, two thousand and twenty one with regard to the in form percent military anthrax, vaccination that was published in the American Mecall Journal of epics by a Mr, be Blacke as a lawyer, and it was probably back to two thousand and seven October edition. If you enjoyed what you heard. If you have an interest in medical ethics, please, like the show, leave a rating share with someone else that may benefit from this. If you have any specific questions about medical ethics by website seen redly MD, I have a couple of lakes where you can actually send me a consultation and we can chat about it and hopefully come to a solution to tune in neck, quick to another episode of curbside eftes, a podcast that helps you make better ethical and EFFIA decisions for the benefit of your patient